Stress First Aid for Health-care Workers: An Indicated Mental Illness Prevention Program for Nursing Education.

Spurred by a global pandemic, the incidence and prevalence of stress-related injury and illness continues to increase amid an overburdened nursing workforce that has remarkably and reliably performed on the frontlines of health care. Indicated mental illness prevention programs such as Stress First Aid for Healthcare Workers create an opportunity to target the acute and chronic expressions of stress experienced by nurses earlier through coordinated peer support with the goals of preserving life, preventing further harm, and promoting recovery. This article will describe how a Stress First Aid program was operationalized at a school of nursing at a private university.

Buddy Care, a Peer-to-Peer Intervention: A Pilot Quality Improvement Project to Decrease Occupational Stress Among an Overseas Military Population.

INTRODUCTION: Occupational stress can have a direct influence on worker safety and health. Navy medical professionals are known to neglect self-care, putting them at risk for deteriorations in psychological health that can lead to adverse patient outcomes. To support medical professionals, a peer-to-peer intervention called Buddy Care, embedded in Navy Medicine's Caregiver Occupational Stress Control (CgOSC) program, was evaluated. Strategies to prevent and better manage occupational stress are vital to improve the health care providers' abilities to cope with day-to-day stressors, which is crucial to maintaining mission readiness. The overarching aim of this quality improvement pilot project was to implement and evaluate Buddy Care and to provide context as an evidenced-based peer intervention and leadership tool at a military hospital in Guam. This project is the first to implement and evaluate Buddy Care intervention for an active duty U.S. Navy population stationed overseas. MATERIALS AND METHODS: A convenience sample of 40 Navy active duty assigned to three inpatient units were offered Buddy Care intervention, which was introduced by conducting a Unit Assessment. A pre-test and 3- and 6-month post-test intervention design used a self-administered, 79-item CgOSC Staff Wellness Questionnaire which included five validated measures to assess the independent variable: (1) Response to Stressful Experience Scale, (2) Perception of Safety, (3) Horizontal Cohesion, (4) Perceived Stress Scale, and (5) Burnout Measure, short version. This project was determined as exempt by the Department of Navy Human Research Protection Program and did not require further review by the Institutional Review Board. RESULTS: Of the 40 questionnaires collected, 39 were partially completed. Paired sample t-tests were conducted between designated time-points to maximize the sample size and retain the repeated measures nature of the outcome variables. The small sample size allowed for statistical comparisons; however no statistically significant differences were found across the time-points. There was a large effect size for Perceptions of Safety and a medium effect size for Burnout Measure from baseline to 3 months, with both lowered at the 6 months. Although the sample size was too small to achieve statistical significance, the effect size analysis suggested that significance might be obtained with a larger sample. CONCLUSION: The small number of participants and missing data significantly limited the ability to identify reliable changes across time-points. Despite the lack of statistically significant findings, there was an unintended positive result. The Unit Assessment piqued the interest of other departments, and during the project period, 11 departments requested a Unit Assessment. Although there were no requests for Buddy Care intervention from the targeted sample, it was occurring an average of 40 times per month throughout the command. Replication of this project in a similar setting is encouraged so that Buddy Care can be further evaluated. Understanding the effectiveness of well-mental health programs that promote early intervention and prevention efforts may contribute to a psychologically tougher medically ready force. Shortly after project completion, a CgOSC Instruction was approved by the Navy Surgeon General, highlighting the importance of CgOSC and Buddy Care on the operational readiness of Navy Medicine.

Military Service-Related Post-traumatic Stress Disorder: Finding a Way Home.

Mental illness and injury, including post-traumatic stress disorder, represents a significant source of disability and morbidity among military and veteran populations. This article explores the pathophysiology, identification, and treatment of military service-connected trauma-related and stressor-related disorders. Particular attention is given to trauma informed care, evidence-based practice recommendations, and the sequencing of psychotherapy and pharmacotherapy in pursuit of optimal patient outcomes.

Concordant Actions in Suicide Assessment Model.

This article offers an alternative conceptualization from which a health care provider can consider and respond to client-based suicidal ideation and behavior. Pragmatically explored through the prism of locus of control, Rogerian psychotherapy principles, Peplau's theory of interpersonal relations, and the work of Kay Redfield Jamison, the Concordant Actions in Suicide Assessment (CASA) model frames clinical decision making along a continuum defined by concordant and state-based action. Therein, cognitive reframes are offered to illustrate how to apply the CASA model in clinical practice.

Military Culture Implications for Mental Health and Nursing Care.

With over 13 years of war and military combat operations, the number of veterans, military families, and service members with mental health needs continues to increase across civilian and federal healthcare services. Knowledge about severe battle wounds, traumatic brain injury, and traumatic stress has influenced the delivery of healthcare. The invisible wounds of war associated with brain injury and traumatic stress will increase clinical care challenges into the foreseeable future. The purpose of this article is to describe two interrelated concepts, military cultural competence and stress injuries. The authors also differentiate stress reactions versus stress injury. Nurses with military cultural competence and knowledge about stress injuries will be better able to deliver patient-centered care to patients with military culture experiences.